Abstract
BackgroundTop tier commercial physical activity apps rarely undergo peer-reviewed evaluation. Even fewer are assessed beyond six months, the theoretical threshold for behaviour maintenance. The purpose of this study was to examine whether a multi-component commercial app rewarding users with digital incentives for walking was associated with an increase in physical activity over one year.MethodsThis 12-month quasi-experimental study was conducted in two Canadian provinces (n = 39,113 participants). Following a two-week baseline period, participants earned digital incentives ($0.04 CAD/day) every day they reached a personalized daily step goal. Mixed-effects models estimated changes in weekly mean daily step count between the baseline period and the last two recorded weeks. Models were fit for several engagement groups and separately by baseline physical activity status within engagement groups.ResultsNearly half of participants (43%) were categorized as physically inactive at baseline (fewer than 5000 daily steps), and 60% engaged with the app for at least six months [‘Regular’ (24–51 weeks of step data) or ‘Committed’ sub-groups (52 weeks)]. Weekly mean daily step count increased for physically inactive users regardless of engagement status (P < .0001). The increase was largest for ‘Regular’ and ‘Committed’ participants—1215 and 1821 steps/day, respectively. For physically active participants, step count increases were only observed in the ‘Committed’ sub-group (P < .0001). Effect sizes were modest-to-medium depending on the sub-group analyzed.ConclusionsA commercial app providing small but immediate digital incentives for individualized goals was associated with an increased weekly mean daily step count on a population-scale over one year. This effect was more evident for physically inactive and more engaged participants.
Highlights
Despite the health benefits of habitual moderatevigorous physical activity (PA), [1,2,3] global rates are precipitously low [4, 5]
PA apps make up the bulk of all mHealth apps (30%, or roughly 100,000 apps) [17]
Low PA app engagement leading to small effects and little sustainability have been industry hallmarks [17,18,19]
Summary
Despite the health benefits of habitual moderatevigorous physical activity (PA), [1,2,3] global rates are precipitously low [4, 5]. The number of mHealth apps published in the major app stores continues to rise with 325, 000 published in 2017, up 34% from the previous year [14] This increase in part reflects evolving smartphone capabilities (e.g., built-in accelerometers, geo-location). The majority of adults (approaching 90%) in the US and Canada, for example, carry a PA monitoring device (i.e. a smartphone accelerometer) most of the time [13] This presents an unprecedented opportunity to deliver more precise public health interventions and bridge well-worn PA divides (e.g., gender PA gaps) [16] using instantaneous PA data to set and adjust realistic PA goals, provide immediate feedback, link users with friends to support long-term change, and so on. The purpose of this study was to examine whether a multi-component commercial app rewarding users with digital incentives for walking was associated with an increase in physical activity over one year
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